Moving from “pay and chase” to pre-pay identification

Technology for addressing fraud, waste, and abuse (FWA) in healthcare claims has changed exponentially over the past 25 years.

This creates an opportunity to fight fraud in a way that enables the goals of healthcare payer organizations. New analytic models give greater insights into identification of FWA. Advanced computing models are reducing the operating cost of technology, making it accessible to enterprises of all sizes, while robotic and intelligent automation is improving the accuracy of detection. More flexible platforms are enabling greater collaboration across the enterprise and standards-based cybersecurity practices are protecting the data.  

Paralleling this advance in technology has been the increasing speed and sophistication of healthcare fraud tactics and techniques. Both growth curves reflect a focus on a retrospective “pay and chase” model that identifies and recovers FWA after payment is made.

This paper presents the preferred method of addressing FWA, pre-pay identification and prevention, now enabled by technology advances in analytics, cloud, security and collaboration.